Joint damage, such as dislocation or ligament tearing, is often a result of connective tissue damage, weakening or breaking the connection between the soft tissue and bone. Resultant weakening can lead to recurring dislocation or reduced joint integrity.
For joint surgery, such as anterior cruciate ligament reconstruction surgery, a bone tunnel is formed in each of two bones of the joint. In knee surgery, these are the femur and the tibia. Preferably, the bone tunnel is formed by drilling a core out through the bone such that the core might be used to form the bone plug in the composite graft. The bone plugs are machined to form two longitudinal substantially parallel grooves opposite one another. At least one ligament replacement, such as a semitendinosus tendon, and/or gracilis, is extended between both of two bone plugs along the parallel grooves in each plug. The ligament replacement is attached to the two bone plugs. Each bone plug is inserted into one of the bone tunnels and secured therein by an interference screw. The use of the bone-tendon-bone composite graft of the invention results in a reconstructed cruciate ligament, also, in accordance with an embodiment the present invention.
Although the lengths of the anterior and posterior cruciate ligaments have been well characterized in the literature, there are few studies of the actual length of these ligaments or the size needed for reconstruction grafts. Current placement of ligament reconstruction surgery is based on current recommendations, and the intra-articular graft length less than published values for the ligaments themselves, and that the patella tendon graft is of adequate length to be used for reconstruction of these ligaments. (Miller, L., et al., Cruciate ligament graft intra-articular distances, Arthroscopy: J of Arthro & Related Surg, 13:3, 291-295).
Intra-articular entry points for ligament reconstruction was traditionally performed using landmark recognition, requiring a constant anatomical landmark, such as the intercondylar notch, to orient placement of a guide. Many times, the placement of intra-articular ligament reconstruction tunnels was too far anterior, resulting in small surgical tunnels, uneven bone plug reconstruction, and delayed graft failure. Alternatively or in conjection with landmark recognition, tunnel placement is based on computer navigation. However, landmark recognition and computer navigation assume similar patient anatomy with respect to the patient's bones and ligaments. Multiple published studies show current reconstruction technology has an inaccurate placement and therefore non-anatomic restoration of knee kinematics. Accurate ligament attachment shows improved joint kinematics. However, studies of current technologies indicate there exists a high probability for inaccurate placement during reconstruction, and therefore non-anatomic restoration of the joint. Accordingly, there exists a need for an improved ligament reconstruction guide to allow better anatomical placement during reconstruction surgery.